Routine inspection·January 16, 2025

Licensing Program Analyst (LPA)s Mary Flores and Nicol Wesley conducted an unannounced annual visit at the facility using the CARE inspection tool. LPAs met with David Fontecha and explained the reason of the visit. The facility is licensed to served 6 non-ambulatory residents age range 60 and over, of which 1 may be bedridden and hospice waiver for 6. The facility has 6 bedrooms, 1 bathroom, a dining room, a living room, a detached garage, a detached laundry room, back patio and a front yard. LPAs conducted a tour of the facility with Juan Fontecha and observed the following: Facility is in good repair inside and outside. Living and dining area are clean and have sufficient sitting area for activities. Kitchen is clean, food was observed sufficient for at least 2 days of perishables and 7 days of non-perishables. Current residents do not have special diets. Sharps were observed locked on a drawer and cleaning supplies were observed locked under the sink. Six (6) resident's rooms were observed and each has sufficient lighting, furniture, and bedding supplies. Bedroom #1 has a covered fireplace. Full bed rails were observed in bedroom #4. Bathroom was observed with skid mat, grab bars and water temperature was tested at 118.5 degrees F., which is within the required 105-120 degrees F. Garage is used for storage of emergency food supplies and infection control supplies. The backyard was observed clean and has a shaded seating area. Due to the winds backyard fence was knocked down and observed on the floor. Administrator will ensure that is clean up by 1/20/25. Interlace smoke/carbon monoxide detectors were tested during the visit and in working condition. Fire extinguishers were observed and last checked on 10/8/24. There are no large bodies of water at the facility. License, PUB 475 Let us Know poster, Long Term Care Ombudsman poster, personal rights were posted in the dining area. (CONTINUED ON LIC 809C) LPAs reviewed medication and files for 5 residents. Resident #2(R2) in bedroom #4 has half bed rail request on file and per file review is not on hospice. LPAs reviewed 5 staff files. Training was observed for all residents. Administrator certificate was observed for Diana Castellanos #6073850740 exp. date: 1/6/27. LPAs reviewed infection control plan and disaster emergency plan. Last fire drill was conducted on 11/6/24. A deficiency has been noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Mariam Nikogsyan and provided a copy of report, LIC 809D, and appeal rights.